| Abstract | Fractures around the knee region comprise a numerous types and wide variation of injuries. The knee joint is a complex and one of the most important weight bearing joints in the human body, making him susceptible to different pathological states. It is formed by three different bones; distal femur, patella and proximal tibia. The stability and rigidity of the knee is made by balanced and intertvened connections of musculo-ligamentous system. The most important representatives of the ligamentous system are: anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), patellar ligament (PL), medial collateral ligament (MCL) and lateral collateral ligament(LCL). The main stabilizers of the musculoskeletal system are the extensors, flexors, adductors and abductors of the femur, whose distal tendons attach at various points on the knee joint, together with the tibial and fibular muscles and their proximal tendon attachments. However, this paper will be concentrated on the skeletal system of the knee region. The focus will be centered to classifications of fractures of each individual bone in the joint, their anatomical structure, epidemiology, etiology, clinical picture, and most importantly different ways of treatment approach. The fractures around the knee region occur in both high energy trauma, such as car accidents, and low energy traumas, such as falls, contact sports, etc. However, high energy trauma injuries comprise a majority of cases of these kind of fractures. Due to this, surgeon’s option for treatment is mostly by surgical approach.Clinically, the patients present with pain in the affected limb, edema, deformity of the leg and inability to stand on their feet. Clinical picture can vary depending on the location of the fracture together with damage of the surrounding structures. This is especially important considering supracondylar and proximal tibial fractures where cruciate and
collateral ligaments are susceptible to injury due to their connection and proximity withbones itself. The definitive diagnosis is made by radiological imaging, anterior, posterior and lateral views, respectively. In most cases, MRI and CT provide visualization of the soft tissue injuries in the extensive injuries of the knee region, helping the surgeon to plan the definitive treatment option. Surgical open reduction and internal fixation is nowadays concerned to be a superior option of treatment in respect to improved alignment, bony union and functional outcome concerning the knee range of motion. |
| Abstract (croatian) | Prijelomi oko regije koljena sadrže brojne vrste i široke varijacije ozljeda. Zglob koljena je složen i jedan od najvažnijih zglobova u podnošenju težine u ljudskom tijelu, što ga čini osjetljivim na različita patološka stanja. Tvore ga tri različite kosti; distalni femur, patella i proksimalna tibija. Stabilnost i krutost koljena postižu se uravnoteženim i isprepletenim vezama mišićno-ligamentnog sustava. Najvažniji predstavnici ligamentnog sustava su: prednji križni ligament (ACL), zadnji križni ligament (PCL), patelarni ligament (PL), medialni kolateralni ligament (MCL) i lateralni kolateralni ligament (LCL). Glavni stabilizatori mišićno-koštanog sustava su ekstenzori, fleksori, aduktori i abduktori femura, čije se distalne tetive pričvršćuju na različitim točkama na zglobu koljena, zajedno s tibialnim i fibularnim mišićima te njihovim proksimalnim dodacima tetiva. Ovaj će se rad koncentrirati na koštani sustav regije koljena. Fokus će biti usmjeren na klasifikacije prijeloma svake pojedine kosti u zglobu, njihovu anatomsku strukturu, epidemiologiju, etiologiju, kliničku sliku i najvažnije različite načine liječenja. Do prijeloma oko regije koljena dolazi kod visokoenergetskih trauma, poput automobilskih nesreća, i kod niskoenergetskih trauma, poput padova, kontaktnih sportova itd. Međutim, ozljede s visokom energetskom traumom čine većinu slučajeva takve frakture. Zbog toga su mogućnosti kirurga za liječenje uglavnom operativnim pristupom. Klinički su bolesnici prisutni s bolovima u zahvaćenom udu, edemom, deformitetom noge i nemogućnošću stajanja na noge. Klinička slika može varirati ovisno o mjestu prijeloma zajedno s oštećenjem okolnih struktura. To je posebno važno s obzirom na suprakondilarne i proksimalne prijelome tibije, gdje su oštećeni i kolateralni ligamenti osjetljivi na ozljede zbog povezanosti i blizine uz samu kost. Konačna dijagnoza postavlja se radiološkim snimanjima, pogledima sprijeda, straga i bočno. U većini slučajeva MRI i CT pružaju vizualizaciju ozljeda mekog tkiva kod opsežnih ozljeda regije koljena, pomažući kirurgu da planira definitivnu mogućnost liječenja. Kirurški otvorenaredukcija i unutarnja fiksacija danas se smatraju superiornom opcijom liječenja s obzirom na poboljšano usklađivanje kostiju i funkcionalni ishod u vezi s kretanjama koljena. |
